Your form message has been successfully sent.

You have entered the following data:

Fill out the form below and you will be contacted immediately.

Please correct your input in the following fields:

Error while sending the form. Please try again later.

Practice Name *

Doctor's Name *

Telephone # *

E-mail address: *

Number of FFS Medicare Patients (Not in an HMO) *

I am NOT currently participating in another ACO.

I AM currently participating in another ACO.

Captcha (spam protection code) *

Note: Fields marked with * are required

Please be aware that the contents of this form are not encrypted

Print Sitemap
Copyright 2019 Accountable Care Medical Group of Florida, Inc. For general questions or additional information about Accountable Care Organizations, please visit www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.

Web View Mobile View

Logout Edit page